腹股沟股疝：超声检查对临床特征不明确患者的准确性

Inguinofemoral hernia: accuracy of sonography in patients with indeterminate clinical features.

作者信息

Robinson Philip, Hensor Elizabeth, Lansdown Mark J, Ambrose N Simon, Chapman Anthony H

机构信息

Department of Radiology, Leeds Teaching Hospitals, St. James University Hospital, Chancellor Wing, Beckett St., Leeds LS9 7TF, United Kingdom.

出版信息

AJR Am J Roentgenol. 2006 Nov;187(5):1168-78. doi: 10.2214/AJR.05.1251.

DOI:10.2214/AJR.05.1251

PMID:17056901

Abstract

OBJECTIVE

The objective of our study was to investigate the accuracy of sonography in patients with symptoms suggestive of a hernia and normal or equivocal clinical examination findings.

SUBJECTS AND METHODS

Fifty-nine consecutive patients (47 men, 12 women; median age, 51 years; range, 19-82 years) were enrolled in a prospective study of sonography and herniography for investigation of inguinofemoral pain. All patients were referred with a history suggestive of hernia but with equivocal clinical features by three experienced surgeons. All patients underwent sonography and herniography examinations performed by experienced radiologists blinded to clinical details. The imaging variables recorded for each side were normal (including posterior inguinal wall bulging), hernia (indirect, direct, femoral, and abdominal wall), or nondiagnostic. The percentage of exact agreement, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for sonography and herniography and were compared with surgery when performed; then all sides for sonography were compared with herniography.

RESULTS

Surgery was performed in 18 patients (31%) on 21 sides and found hernia (n = 20) and patulous posterior inguinal wall (with no hernia) (n = 1). Compared with surgery, the results of sonography versus herniography, respectively, were exact agreement (91% vs 71%), sensitivity (95% vs 70%), specificity (100% vs 100%), PPV (100% vs 100%), and NPV (50% vs 14%). The sensitivity of sonography was significantly higher than that of herniography (McNemar test, p = 0.025). Both techniques had one false-negative in the same patient. Herniography had five additional false-negatives identified as hernias at sonography and surgery. Compared with herniography as the reference, the sonography findings were in exact agreement in 91% (107/118) of the cases; and sensitivity was 90% (19/21); specificity, 91% (88/97); PPV, 68% (19/28); and NPV, 98% (88/90).

CONCLUSION

Sonography is an accurate technique for the detection of inguinofemoral hernias in patients with clinically equivocal findings.

摘要

目的

我们研究的目的是调查超声检查在有疝症状但临床检查结果正常或不明确的患者中的准确性。

研究对象与方法

连续59例患者（47例男性，12例女性；年龄中位数51岁；范围19 - 82岁）纳入一项关于超声检查和疝造影检查的前瞻性研究，以调查腹股沟股部疼痛。所有患者均因有疝病史转诊，但三位经验丰富的外科医生检查发现临床特征不明确。所有患者均接受了由对临床细节不知情的经验丰富的放射科医生进行的超声检查和疝造影检查。记录每侧的影像变量为正常（包括腹股沟后壁膨出）、疝（间接疝、直接疝、股疝和腹壁疝）或无法诊断。计算超声检查和疝造影检查的完全一致率、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），并与手术结果进行比较；然后将超声检查的所有侧别与疝造影检查进行比较。

结果

18例患者（31%）的21侧进行了手术，发现疝（n = 20）和腹股沟后壁松弛（无疝）（n = 1）。与手术相比，超声检查和疝造影检查的结果分别为：完全一致率（91%对71%）、敏感性（95%对70%）、特异性（100%对100%）、PPV（100%对100%）和NPV（50%对14%）。超声检查的敏感性显著高于疝造影检查（McNemar检验，p = 0.025）。两种检查在同一患者中均有1例假阴性。疝造影检查还有5例假阴性，在超声检查和手术中被诊断为疝。与以疝造影检查为参照相比，超声检查结果在91%（107/118）的病例中完全一致；敏感性为90%（19/21）；特异性为91%（88/97）；PPV为68%（19/28）；NPV为98%（88/90）。